Provider Demographics
NPI:1215210661
Name:DENEVE, PAMELA GAIL
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:GAIL
Last Name:DENEVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 3RD ST NW STE 202
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4605
Mailing Address - Country:US
Mailing Address - Phone:863-595-1071
Mailing Address - Fax:863-595-1073
Practice Address - Street 1:250 3RD ST NW STE 202
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4605
Practice Address - Country:US
Practice Address - Phone:863-595-1071
Practice Address - Fax:863-595-1073
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14666225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist